title: Improving ATLS performance in simulated pediatric trauma resuscitation using a checklist.
abstract: OBJECTIVE
  To develop a checklist for use during pediatric trauma resuscitation and test its effectiveness during simulated resuscitations.
  
  
  BACKGROUND
  Checklists have been used to support a wide range of complex medical activities and have effectively reduced errors and improved outcomes in different medical settings. Checklists have not been evaluated in the domain of trauma resuscitation.
  
  
  METHODS
  A focus group of trauma specialists was organized to develop a checklist for pediatric trauma resuscitation. This checklist was then tested in simulated trauma resuscitations to evaluate its impact on team performance. Resuscitations conducted with and without the checklist were compared using the Advanced Trauma Life Support (ATLS) performance score, designed to measure adherence to ATLS protocol, and surveys of team members' subjective workload.
  
  
  RESULTS
  The focus group generated a checklist with 56 items divided into 5 sections corresponding to different phases of trauma resuscitation. In simulation testing, the total ATLS performance score was 4.9 points higher with a checklist than without (P < 0.001), with most of this difference related to improvement in performance of the secondary survey (+3.3 points, P < 0.001). Overall, workload scores were not affected by the addition of the checklist.
  
  
  CONCLUSIONS
  Implementing a checklist during simulated pediatric trauma resuscitation improves adherence to the ATLS protocol without increasing the workload of trauma team members.
authors.affiliation: Divisions of *Trauma and Burn Surgery and †Emergency Medicine, Children's National Medical Center, Washington, DC ‡College of Information Science and Technology, Drexel University, Philadelphia, PA §Human Factors and Applied Cognition, Department of Psychology, George Mason University, Fairfax, VA.
authors.forename: Samantha E
authors.initials: SE
authors.lastname: Parsons
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Carter
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Waterhouse
authors.forename: Jennifer
authors.initials: J
authors.lastname: Fritzeen
authors.forename: Deirdre C
authors.initials: DC
authors.lastname: Kelleher
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Oʼconnell
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Sarcevic
authors.forename: Kelley M
authors.initials: KM
authors.lastname: Baker
authors.forename: Erik
authors.initials: E
authors.lastname: Nelson
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Werner
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Boehm-Davis
authors.forename: Randall S
authors.initials: RS
authors.lastname: Burd
mesh_terms: D061906:Advanced Trauma Life Support Care / Q000379:methods / Q000592:standards*; D057189:Checklist; D002648:Child; D002983:Clinical Competence; D003697:Delphi Technique; D017144:Focus Groups; D019983:Guideline Adherence; D006776:Hospitals, Pediatric; D006801:Humans; D016014:Linear Models; D010348:Patient Care Team / Q000592:standards*; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D012151:Resuscitation / Q000379:methods / Q000592:standards*; D014193:Trauma Centers; D016526:Workload